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Antinuclear antibody testing in pleural fluid for the diagnosis of lupus pleuritisPleural Diseases Unit, Department of Internal Medicine, Arnau de Vilanova University Hospital, IRBLLEIDA, Lleida, Spain; Department of Internal Medicine, Arnau de Vilanova University Hospital, Alcalde Rovira Roure 80, 25198 Lleida, Spain jporcelp{at}yahoo.es
Department of Internal Medicine-Autoimmune Diseases, Vall d'Hebron University Hospital, Barcelona, Spain
Department of Laboratory Medicine, Arnau de Vilanova University Hospital, Lleida, Spain
Division of Internal Medicine, Clinica Recoletas, Albacete, Spain
Pleural Diseases Unit, Department of Internal Medicine, Arnau de Vilanova University Hospital, IRBLLEIDA, Lleida, Spain
Department of Internal Medicine-Autoimmune Diseases, Vall d'Hebron University Hospital, Barcelona, Spain
Division of Pulmonary Medicine, Vanderbilt University, Nashville, TN, USA
We sought to determine whether measuring antinuclear antibodies (ANA) and their specificities [dsDNA, extractable nuclear antigens (ENA)] on pleural fluid may contribute to the differential diagnosis of pleural effusions. ANA were tested by indirect immunofluorescence on Hep-2 cells in the pleural fluid of 266 patients with effusions of different etiologies, including 15 lupus pleuritis. The cutoff value for diagnostic use was set at 1: 160. Pleural fluid analysis of specific autoantibodies, such as anti-dsDNA and anti-ENA, was also performed if a positive ANA test was obtained. All patients with lupus pleurisy and 16 of 251 (6.4%) patients with pleural effusions secondary to other causes were ANA positive. Fifty-six percent of the positive ANAs in non-lupus pleural fluids were due to neoplasms. The pleural fluid ANA titers were low (
Key Words: antinuclear antibodies • malignancy • pleural effusion • systemic lupus erythematosus
Lupus, Vol. 16, No. 1,
25-27 (2007) This article has been cited by other articles:
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1: 80) or absent in two patients with systemic lupus erythematosus (SLE) and effusions due to other factors. Whereas ANA staining patterns in pleural fluid did not help to discriminate lupus pleuritis from non-lupus etiologies, the absence of pleural fluid anti-dsDNA or anti-ENA favored the latter. ANAs in pleural fluid provided no additional diagnostic information beyond that obtained by the measurement in serum and, therefore, these tests need not be routinely performed on pleural fluid samples. However, in patients with SLE and a pleural effusion of uncertain etiology, lack of ANAs or specific autoantibodies in pleural fluid argues against the diagnosis of lupus pleuritis. 
